E-cigarettes: What are they and should we be worried?

In the last few weeks I have been contacted by a number of schools asking for my advice on how to deal with students who have been caught with electronic cigarettes (or e-cigarettes as they are better known). I have to say that I really didn't know what to tell them. Although these devices have been around for a few years I really didn't think that they would make it into Australian schools to any great extent and as regular readers of my blog would know, I have been much more concerned about the growing interest in sheesha or hookah smoking. It appears that I was wrong, I am now asking schools that I visit whether they're seeing these devices and almost everyone of them has ...

So what exactly are e-cigarettes and how are they different from traditional cigarettes? More importantly, what are the harms associated with these devices, particularly when it comes to young people?

Put simply an e-cigarette is a nicotine delivery device that simulates tobacco smoking by producing a vapor. Operated by a battery, it vaporizes a liquid solution (called 'e-liquid' or 'e-juice) containing nicotine (amongst other things, including a range of flavours from fruit through to chocolate and bubble-gum) ) and is promoted by manufacturers as being 'safer' than traditional smoking because it is a tobacco-free product that eliminates the burning process. When the liquid is turned into a vapor, this is inhaled or 'vaped'. Confusing the issue is that there are also some of these e-liquids that are nicotine free, with these devices simply releasing a flavoured vapor such as Red Bull!

A WHO Report released earlier this year found that since 2005, the e-cigarette industry has grown from one manufacturer in China to an estimated US$3 billion global business with 466 brands. Worryingly, it is a market in which the tobacco industry is taking a greater stake, with many of the smaller manufacturers being bought out by the tobacco giants - it is obviously regarded as the future of 'smoking'. What is quite amazing is how quickly the technology is changing - I was at a presentation on the weekend and we were shown one product called the 'Supersmoker', an e-cigarettes that connects to a smartphone by Bluetooth and plays music and receives phone calls! Others provide feedback on smoking statistics, while one particular brand offers a feature that alerts the user when anyone else using that brand is nearby.

The 'positive' aspect of these devices (i.e., vapor versus smoke) is being pushed heavily with recent research suggesting that they can be used effectively as a nicotine replacement therapy (NRT). They certainly appear to be used by some to help quit or reduce smoking, as well as to prevent relapse and there is no doubt that they reduce secondhand smoke. Smokers also sing their praises because they allow them to 'vape' in places they haven't been allowed to smoke. The tobacco prevention lobby however is split down the middle on whether these 'positives' outweigh the potential public health damage e-cigarettes could cause. So why is there debate amongst anti-smoking groups and what are my views on these devices?

Anything that assists smokers to quit the habit is a good thing but I must confess I am very concerned about the impact that these products may have on young people. We have done such a great job in this country where smoking is concerned (we officially have the lowest daily smoking rate in the world) and that is essentially due to us successfully making smoking be seen as anti-social ... Even though e-cigarettes don't involve 'smoking' per se, they still simulate the practice and together with other novel methods of smoking becoming increasingly popular (i.e., sheesha) there is a very real danger that the 'anti-social' message could be eroded over time, i.e.,if public vaping becomes more widespread, it will certainly increase the visibility (and possibly perceived acceptability) of a behaviour that resembles smoking. If we follow the US (and we usually do!) advertising and marketing of these products will become more and more aggressive, particularly via the Internet and social media. Add celebrity endorsements (and there have been many in the States - take a look at this American advert featuring ex-Playboy centrefold Jenny McCartney) there is a real danger of a shift in attitude towards smoking in general ...

My greatest concern however is the involvement of the tobacco industry. They have a history of targeting vulnerable groups, including young people, and when you look at some of the standard features of these products (e.g., child-friendly flavours) and other innovations that are being introduced such as devices being able to play music and receive phone calls, it's not surprising that many in the wider public health area are worried.

This really is a 'watch this space' area. E-cigarettes are not approved as therapeutic products but they can be purchased legally without nicotine across Australia.  E-liquid bottles or cartridges containing nicotine can be bought online, even though in some jurisdictions, obtaining, purchasing, possession and/or using nicotine without a permit is an offence. In addition, some states have also introduced legislation banning e-cigarettes being used in public areas and in the workplace. Most schools I have had discussions with have decided to see them as tobacco products, whether or not they contain nicotine, and deal with them accordingly.

But it is these nicotine-free disposable devices that are the real issue as far as most young Australians are concerned at the moment. A range of these products are now available at the local corner store ('Shisha-sticks' are most probably the most well-known) and come in a wide variety of flavours. It is these that I am being asked about by more and more students when I visit schools,  usually wanting to know what is in them and what are the potential harms ... That's hard for me to answer, I don't know how parents or teachers would know what to say. Summing it up nicely for me is a comment made by a Year 10 girl at the end of a discussion about a friend of her's who was regularly vaping berry-flavoured Shisha sticks ...

"If all she gets from it is a vapor that tastes of berries, why doesn't she just suck on a lolly? Seems like a lot of money to spend on a flavour that you could get much cheaper somewhere else!"

Out of the mouth of babes ... but it does highlight that it is most probably the simulation of smoking that is actually the real attraction of these products for the young and that, as I've already said, is the real problem - all of a sudden, smoking becomes 'cool' again.